Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis



To appraise the available evidence on advanced practice physiotherapy (APP) models of care (MoC) in specialized secondary care such as orthopaedic, rheumatology or neurosurgery outpatients’ clinics for adults with spinal pain.


Systematic review with meta-analysis. Electronic searches were conducted up to July 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. Studies on APP MoC in specialized secondary care for adults with spinal pain were included.


Eighteen studies (n = 9405), including two randomized controlled trials and sixteen observational studies were included. One study was considered at high quality, fourteen studies were considered of moderate quality and three were considered of low quality. Pooled results for change in disability for patients with spinal pain reported no significant difference between APP and usual medical care (UMC). Mean wait time for initial consultation was lower with APP (1–9.4 weeks) than with UMC MoC (23–65 weeks). Following the implementation of APP MoC, wait time for a consultation with a medical specialist was reduced (6–16 weeks). Physiotherapists in APP MoC managed independently 89.2% of the patients referred (n = 8393). Stakeholders and patients reported high satisfaction with APP care.


APP MoC and UMC likely result in comparable pain, disability and quality of life improvement for adults with spinal pain. However, APP MoC have the potential to improve health care access by reducing wait time for consultation in specialized care and maintaining a high level of satisfaction among stakeholders and patients.

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We are grateful to Dr. Keith Smart and Dr. Karin S. Samsson for sharing their data in order to stratify results for patients with spinal pain from their published articles. We thank Savannah Stewart for the copy edit of this review.


The project was funded with Dr. Desmeules’ Canadian Institutes of Health Research Program New Investigator Salary and Research Award in Clinical Rehabilitation (201609NCR-375311–130299) and Simon Lafrance, PhD, scholarship (Fondation de l’Hôpital Maisonneuve-Rosemont).

Author information




Simon Lafrance: study protocol design, literature searches, study selection, data extraction, risk-of-bias analysis, data analysis and writing the manuscript. Jean-Gabriel Lapalme: verified data extraction, risk-of-bias analysis and review the manuscript. Marianne Méquignon: study selection and review the manuscript. Carlo Santaguida: study protocol review and review the manuscript. Julio Fernandes: review the manuscript. François Desmeules: study protocol design, assist SL in data analysis and in writing the manuscript.

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Correspondence to Simon Lafrance.

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Carlo Satanguida declares being the Chief Medical Officer for CareAxis, a non-profit network of care involving advanced practice physiotherapists for adults with spinal pain and being a consultant for Medtronic and for Stryker, two medical devices and technology firms. All the other authors declare no conflict or appearance of conflict of interest.

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Lafrance, S., Lapalme, JG., Méquignon, M. et al. Advanced practice physiotherapy for adults with spinal pain: a systematic review with meta-analysis. Eur Spine J (2020).

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  • Advanced practice
  • Physiotherapy
  • Spine
  • Specialized care
  • Health care system